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Is Cardiac Evaluation Before Surgery a Mistake?

Do people with no cardiac symptoms really need coronary artery angiography before surgery? It often results in cardiac interventions such as stents.

Many people anticipating some type of operation other than one on their hearts are sent for cardiac evaluation with coronary artery angiography before surgery.  Surgeons want to make sure that their patients are not at high risk of having a heart attack or stroke in the middle of the procedure. But it is not clear whether this kind of evaluation is helpful, or whether it might result in unnecessary interventions for some patients.

Many People Are Referred for Cardiac Interventions Before Surgery:

A new study of nearly 200,000 people shows that, although most of these individuals did not have cardiac symptoms, nearly half were referred for a stent or bypass graft before surgery. More than half had been taking medicine for angina prior to the evaluation.

This study confirms that many patients who need some type of surgery may have some blockage in their coronary arteries. The majority of these individuals were overweight or obese and they were, for the most part, older men.

Cardiac Stents and Bypass Offer No Benefit for Asymptomatic People Before Surgery:

The conclusions note that randomized controlled trials have shown no benefit in outcomes for asymptomatic patients undergoing cardiac intervention before surgery. Complications from balloon angioplasty, stenting or coronary bypass operations are uncommon but not unheard of. About 0.05 percent of those undergoing catheterization died as a result of that procedure. The journal, JAMA Internal Medicine, published this research under its special “Less Is More” rubric.

JAMA Internal Medicine, online, March 28, 2016

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies..
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